Retinal Detachment

OVERVIEW

Retinal tears commonly
occur when there is traction on the retina by the vitreous inside the eye. In a child's eye, the vitreous has an egg-white consistency and is
firmly attached to certain areas of the retina. Over time, the vitreous gradually becomes thinner, more liquid and
separates from the retina. This
is known as a posterior vitreous detachment (PVD).

PVDs are typically
harmless and cause floaters in the eye; but in some cases, the traction on the
retina may create a tear. Retinal
tears frequently lead to detachments as fluids seep underneath the retina,
causing it to separate and detach.

A retinal detachment
occurs when the retina's sensory and pigment
layers separate.Because it
can cause devastating damage to the vision if left untreated, retinal
detachment is considered an ocular emergency that requires immediate medical
attention and surgery. It is a problem that occurs most frequently in the middle-aged and elderly.

There are three types of
retinal detachments. The most
common type occurs when there is a break in the sensory layer of the retina,
and fluid seeps underneath, causing the layers of the retina to separate. Those who are very nearsighted, have
undergone eye surgery, or have experienced a serious eye injury are at greater
risk for this type of detachment. Nearsighted
people are more susceptible because their eyes are longer than average from
front to back, causing the retina to be thinner and more fragile.

The second most common
type occurs when strands of vitreous or scar tissue create traction on the
retina, pulling it loose. Patients
with diabetes are more likely to experience this type.

The third type happens
when fluid collects underneath the layers of the retina, causing it to
separate from the back wall of the eye. This
type usually occurs in conjunction with another disease affecting the eye that
causes swelling or bleeding.

SIGNS AND SYMPTOMS

Light Flashes

Wavy or watery vision

Veil or curtain obstructing vision

Shower of floaters that resemble spots, bugs, or spider webs

Sudden decrease of vision

DETECTION AND DIAGNOSIS

Retinal detachments are
usually found because the patient calls the doctor's office with a symptom
listed above. It is critical that
these problems are reported early, because early treatment can greatly improve
the chance of restoring vision.

The doctor makes the
diagnosis of a retinal detachment after thoroughly examining the retina with ophthalmoscopy. The retinal surgeon's first concern is to determine whether the macula
(the center of the retina) is attached. This
is critical because the macula is responsible for the central vision. Whether or not the macula is attached determines the type of corrective
surgery required and the patient's chances of having functional vision after
the operation.

Ultrasound imaging of
the eye is also very useful for the doctor to see additional detail of the
condition of the retina from several angles.

TREATMENT

There are a number of
ways to treat retinal detachment. The
appropriate treatment depends on the type, severity and location of the
detachment.

Pneumatic retinopexy is
one type of procedure to reattach the retina. After numbing the eye with a local anesthesia, the surgeon injects a
small gas bubble into the vitreous cavity. The bubble presses against the retina, flattening it against the back
wall of the eye. Since the gas
rises, this treatment is most effective for detachments located in the upper
portion of the eye. In order to
manipulate the bubble into the ideal location, the surgeon may ask the patient
to keep his or her head in a specific position.

The gas bubble slowly
absorbs over the next 1-2 weeks. At
that time, an additional procedure is usually performed to "tack down" the
retina. This can be done either
with cryotherapy, a procedure that uses nitrous oxide to freeze the retina,
sealing it in place, or with laser. Local
anesthesia is used for both procedures.

Some types of retinal
detachments, because of their location or size, are best treated with a
procedure called a scleral buckle. With
this technique, a tiny sponge or band made of silicone is attached to the
outside of the eye, pressing inward and holding the retina in position. After removing the vitreous gel from the eye with a procedure called a vitrectomy, the surgeon usually seals a few areas of the retina into position
with laser or cryotherapy. The scleral buckle is not visible and remains permanently
attached to the eye. This
technique of reattaching the retina may elongate the eye, causing
nearsightedness.

In rare cases where
other types of retinal detachment surgeries are either inappropriate or
unsuccessful, silicone oil may be used to reattach the retina. The vitreous gel is removed and replaced with silicone oil,
which presses the retina into place. While
the oil is inside the eye, the vision is extremely poor.
After the retina has resealed itself against the back of the eye, a
second procedure may be performed to remove the oil.

Early detection is key
in successfully treating retinal detachments and tears. Awareness of the quality of your vision in each eye is
extremely important, especially if you are in a higher-risk group such as
those who are nearsighted or diabetic. Compare
the vision of your eyes daily by looking straight ahead and covering one eye
and then the other.

Notify your doctor
immediately if you notice any of the following:

An obstruction of your peripheral vision (veil, shadow, or curtain)

Sudden shower of floaters

Light flashes

Spider webs

St. Luke's Cataract & Laser
Institute provides this on-line information for educational and
communication purposes only and it should not be construed as
personal medical advice. Information published on this St.
Luke's website is not intended to replace, supplant, or augment a
consultation with an eye care professional regarding the
viewer/user's own medical care. St. Luke's disclaims any and
all liability for injury or other damages that could result from use
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